What finding on a chest X-ray is suggestive of congestive heart failure?

The presence of Kerley B lines on a chest X-ray is indicative of congestive heart failure, as these lines represent interstitial edema associated with the condition. They are short, horizontal lines seen at the lung periphery, near the costophrenic angles. Kerley B lines occur due to fluid accumulation in the interstitial spaces of the lungs as a result of increased pulmonary venous pressure, which often happens in heart failure. Their appearance suggests that the heart is struggling to effectively pump blood, leading to congestion and fluid leakage into lung tissues.

While other findings like pleural effusion can also be associated with heart failure, Kerley B lines specifically point to the underlying mechanism of interstitial edema. Hyperinflation of the lungs may indicate chronic obstructive pulmonary disease rather than heart failure, and consolidation in the lower lobes typically suggests pneumonia rather than fluid overload. Therefore, recognizing Kerley B lines assists in diagnosing congestive heart failure by highlighting the characteristic radiographic changes associated with the increased pulmonary pressures.